# Analysis of mortality predictors in a 1-year cohort of neuropalliative care patients

## TL;DR

This study identifies key factors predicting mortality in neurological patients receiving palliative care, aiming to improve end-of-life care planning.

## Contribution

The study identifies PPS score, the Surprise Question, and weight loss as significant mortality predictors in neurological patients.

## Key findings

- Patients with palliative care indication had a 29.8% mortality rate and 27.7-fold higher death risk.
- PPS score < 40%, a 'no' to the Surprise Question, and weight loss were significant mortality predictors.
- Advanced directives were documented in only 31% of the palliative care group.

## Abstract

Palliative care has been shown to yield benefits in terms of quality of life and therapeutic planning in oncological and non-oncological diseases, but its integration in neurology remains limited.

To evaluate the predictive factors of mortality in neurological patients to improve prognosis.

In this 1-year cohort study, we followed patients aged > 18 years hospitalized in a neurological Semi-Intensive Care Unit in Brazil. The patients were categorized into two groups based on palliative care indication: those with and those without indication. The palliative care criteria included a “no” response to the Surprise Question, a Palliative Performance Scale (PPS) score below 70%, or significant weight loss (> 5%) with associated body changes.

We included 166 patients, 87 with indication and 79 without it. The group with indication had a 29.8% mortality rate (26 deaths) and a 27.7-fold higher risk of death. The factors associated with increased mortality risk within 1 year included PPS score < 40%, answering “no” to the Surprise Question, and weight loss. Notably, 62% (n = 54) of the group with indication were admitted to the Intensive Care Unit (ICU), compared to 12% (n = 12) in the group without indication. Advanced directives were only documented in 31% (n = 27) of the group with indication and in 59% (n = 16) of the patients who died. Prognostic assessment in neurological diseases is challenging due to limited data.

In the present study, we found that the PPS score, the Surprise Question, and weight loss were significant predictors of mortality within 1 year. These findings highlight the need for further research to provide better end-of-life markers and ensure greater autonomy in neurological disease management.